IMPLANTABLE DEFIBRILLATORS: ARE THEY WORTH THE EXPENSE?

February 3, 2005

Implantable cardioverter-defibrillators (ICDs) have not significantly reduced mortality rates in patients who have suffered heart attacks, according to the New England Journal of Medicine. However, new and expanded Medicare guidelines for the use of ICDs may incur huge costs for the program compared to benefits.

In a study of 674 patients who had experienced heart attacks -- 332 receiving ICD therapy and 342 in a control group -- researchers concluded:

In a follow-up period of 30 months, 62 patients in the ICD group died of heart attacks, while 58 patients died in the control group.

Only 12 deaths were reported due to arrhythmia (irregular heartbeat) in the ICD group, compared with 29 deaths in the control group.

However, the ICD group experienced 50 deaths from other, non-arrhythmiac causes compared to only 29 deaths in the control group.

Last year, the Centers for Medicare and Medicaid Services revised the guidelines on ICDs that would substantially increase the number of patients eligible for ICDs covered by Medicare.

In 2003, 150,000 ICDs were implanted in patients, and that number is expected to grow.

The cost estimate for implanting the devices ranges from $27,000 to $33,000 per year of life saved.

While the up front cost may not seem justifiable when compared to the benefit, some medical experts argue that studies are biased against expensive medical devises, since the short time periods do not reflect long-term benefits.